Background: We continue the previously described prospective cohort study of ritonovir-boosted lopinavir (LPV/r)\r\nmonotherapy for second-line therapy in HIV-infected patients with prior failure and extensive resistance to\r\nnucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), with\r\nthe objective being to determine the three-year treatment responses.\r\nFindings: There were 40 patients with a mean �± SD age of 37 �± 8 years. Median (IQR) baseline CD4 was 123 (37-\r\n245) cells/mm3 and median (IQR) HIV-1 RNA was 55,800 (9,670-100,000) copies/mL. All patients received twice daily\r\nLPV/r 400/100 mg and recycled lamivudine 150 mg. By intend-to-treat analysis at 144 weeks, 26 (65%) and 22\r\n(56%) patients achieved HIV-1 RNA at < 400 and < 50 copies/mL, respectively. In as-treated analysis, the\r\ncorresponding rates were 26 of 28 (93%) and 22 of 28 (78%), respectively. Low-level viral rebound (HIV-1 RNA 50-\r\n400 copies/mL) was found in 6 (15%), 6 (15%), and 4 (10%) patients at week 48, 96 and week 144, respectively.\r\nMedians CD4 at week 48, 96, and 144 were 351, 481, and 584 cells/mm3 and significantly changed from baseline\r\n(all, P < 0.05). There were increments of mean triglycerides at 48 weeks and 144 weeks from baseline (P < 0.05). No\r\nmajor protease resistance-associated mutations emerged after virologic failure.\r\nConclusion: LPV/r monotherapy with recycled lamivudine can maintain long-term virologic suppression in a\r\nrelatively small proportion of patients failing NNRTI-based regimen and having limit option for active NRTI. More\r\nantiretroviral classes are needed be accessible in resource-limited countries.
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